Locomotion & Assistive Devices
When fitting a client for an assistive device such as a walker, cane, or crutches it is vital to have that device properly fitted to accommodate their needs. When fitting a client for an assistive device, the Occupational Therapist must consider factors such as the client's height, weight, physical/mental ability, and disability. These are important when it comes to matching an assistive device to the client in order to avoid falls and prevent further injury. For example, if a client is not yet confident in their ability to walk, fitting them for a cane instead of a walker could impair their ability to participate in their daily occupations due to the risk of falling. Once the right ambulation device is selected, it is crucial to have it properly fitted to their height to prevent injuries to the spine or axilla. When training clients, it is important to keep a gait belt on them at all times in order to prevent injury.
Canes:
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Image retrieved from: https://www.mayoclinic.org/healthy-lifestyle/healthy-aging/in-depth/canes/art-20548206 |
When considering a client for a cane, the therapist must choose between either a standard or quad cane. To make this decision client factors such as stability and mobility must be considered. For the more stable client, a standard cane would be selected and fitted based on their height. The client will stand facing forward with relaxed arms and the therapist will adjust the cane to where the handle is in line with either the client's greater trochanter, wrist crease, or ulnar styloid. The height is adjusted through the use of a push button mechanism on the bottom of the cane. When fitting for a quad cane, the fitting process is the same and the wide legs will face away from the patient.
For maneuvering from a sitting to a standing position, the client will scoot to the edge of the surface they are on and make sure to place their feet firmly on the ground where the toes are positioned under the knees in order to lessen their base of support. Next, they will place the cane in their uninvolved hand and use the stationary surface to push off of to stand up. Once they are standing, they will bring their involved/injured foot and the cane forward at the same time with the uninvolved leg following after in order to efficiently walk. When the client is ready to sit, they will return back to their seat and move backward until their legs are touching the seat surface. Then they will lighten their grip on the cane and use both hands to reach back and grab the seat and sit themselves down in a slow and controlled manner. For a quad cane, this process is greatly similar except for when sitting and standing the client will not keep hold of the cane.
Safety Considerations:
- Never position the cane on the involved/injured side of the body.
- Making sure the client does not walk with the cane too far in front.
- Proper sizing.
- Do not lean on the cane.
- Keep the handle facing backwards.
Crutches:
Image retrived from: https://worldcrutches.com/forearm-crutches-or-underarm-crutches/
Determining which type of crutch will work best for a client is based on their individual ability. For example, if a client can not bear weight through their wrist they would be given lofstrand crutches instead of axillary crutches. In order to fit a client for crutches the therapist must size the device to where the hand grip falls in line with either the greater trochanter, wrist crease, or ulnar styloid. For axillary crutches, the arm pad should be situated two to three finger widths below the axilla (arm pit) to prevent a brachial plexus injury. For lofstrand crutches, the forearm rest should be placed 2/3 up the forearm where the top of the band comes into contact with the olecranon process.
When instructing the client on how to rise from a seated position with crutches I would instruct them to scoot to the edge of their seat and place both crutches in the involved hand and use the other arm to lean forward and push them out of their seat. Once they are standing they would then take the other crutch and place it on the involved side of the body. If the client can only bear weight through one leg, then they would keep that leg extended while rising. In order to properly ambulate, the client will place the tips of the crutches in a tripod position and first move the crutches forward and then swing through them. When sitting down, the client will perform the same actions required to sit with a cane while holding both crutches with the involved hand. It is important to keep in mind that if the client is non-weight bearing then during sitting to standing the leg will stay extended and while walking the leg will be kept off the ground. For lofstrand crutches, this process is the same other than the placement of the arm cuff. The client should put on the cuff after standing and remove it before sitting down while always keeping the handle forward.
Safety Considerations:
- Keep crutches close together when walking.
- Do not place crutches too far in front or behind.
- Do not place the armrest or arm cuff too high.
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| Image retrieved from: https://www.performancehealth.com/drive-universal-platform-walker-crutch-attachment |
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| Image retrieved from: https://www.amazon.com/Deluxe-Button-Folding-Walker-5-Inch/dp/B001HOM4U2 |
For sitting to standing, the client will bring the walker in front of them and scoot to the edge of their seat and push off the surface with their arms; it is important that the client understands they should never use the walker as a way to pull them up! Once standing, the client will then place both hands on the walker ( or place arms on the platform) and push the walker, no more than arm's length, forward along with the involved leg. Then the client will shift their weight to their hands and swing their unaffected leg forward. The client will continue this pattern to properly walk with their device and when they are ready to sit they will come to their chair and back up until their legs touch the surface. Once in position, the client will then reach back one at a time with both hands and guide themself down slowly. If a client is non-weightbearing then the involved extremity will stay extended throughout these processes.
Safety Considerations:
- Do not position the walker too close or too far away from your body.
- Do not sit down until your legs touch the back of the chair.
- Be sure to properly size the walker.
Giles, A. K. & Kraft, S. (2019). MOBI– Mobility Aids. Available from
https://itunes.apple.com/us/app/mobi-mobility-aids-id1205309397
Weisser-Pike, O. (2023, June). Lecture 12: Gait & Locomotion. OT 430 Biomechanics, University of Tennessee Health Science Center
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